a contentious debate about the benefits and costs of advertising drugs to consumers is under way, there
is little doubt this new form of marketing motivates discussions between patients and their physicians.
If the discussions focus on the patient's health complaints,
their diagnostic implications, the meaning of the diagnosis in the context of the patient's life and the
full range of treatment options, both the doctor and the patient will have a healthier and more satisfying
Of course, if ad-motivated discussions focus on specific
brand-name drugs, trivial complaints or procurement issues, such as which products are available on formulary
(or not), ad-based conversations could detract from more meaningful discussions.
The yin and yang of consumer advertising can be illustrated
Imagine a patient who sees an ad for an antidepressant
and recognizes her symptoms as suggestive of major depression. As a result of the ad, she reveals these
symptoms to her doctor. The doctor performs a careful history and physical exam and considers hypothyroidism
a likely explanation for the patient's depression. Testing confirms the diagnosis, and the patient is
successfully treated with thyroid hormone replacement therapy.
In a different scenario, another patient waves the same
ad in the face of her doctor and demands the drug. After taking a cursory history that suggests depressive
symptoms, this physician writes the prescription. Six months later, the patient is hospitalized for severe
The difference between the two scenarios involves more
than the difference between good and bad medicine. The difference is that in the first scenario the ad
is a springboard to a thorough investigation of symptoms, development of a reasonable differential diagnosis
and prescription of appropriate therapy. The doctor in the first scenario remembers her professional responsibility
to evaluate not just the patient's request but also the patient's problem. In the second scenario, the
physician carries the ethos of customer satisfaction to an unsafe extreme.
What should physicians do with patients who make ad-induced requests for prescription drugs? The responsible thing is to direct the conversation back to symptoms, complaints and concerns, from whence a differential diagnosis can emerge and appropriate therapy follow.
However, an overly direct approach may upset patients unnecessarily.
In my own practice, I have found that requests for advertised drugs are often best met with more questions,
asked in a truly neutral way.
By asking questions, the physician begins to understand the context of the request, and his or her concern
for the patient becomes palpable. This opens the way to a more productive clinical dialogue less inhibited
by patient anxiety and physician defensiveness.
Direct-to-consumer advertising of prescription drugs is here to stay. And while there may be abuses,
doctors not need run scared. Physicians should be mindful of the positive opportunities that these prescription
drug ads present using ad-induced requests as a way to nurture more informed patients and create more